Distilling the PHQ-9

Answering with a scale from 0 to 3 how you cope with a daily activity can be reasonably straightforward. But over time, the survey becomes more challenging, especially the questions regarding personal beliefs: 

6. Over the last two weeks, how often have you felt that you are a failure or have let yourself or your family down?

9. Over the last two weeks, how often have you thought that you would be better off dead?

On question 7 (Trouble concentrating on things, such as reading the newspaper or watching television), the PHQ-9 implies that depression can cause difficulties focusing. The impediment is caused by the prefrontal cortex freezing when we go into fight, flight or freeze mode. This part of the brain is responsible for reading, math, and other deep thinking.

When we struggle to focus on reading, we tend to skim, seeking specific information or the general idea of the content. The 1^st time I did the test, I could read all of it with no issues. Once it became a regular thing, I started scanning through for the key points.
At one stage, I could only see two questions:

• Have you let yourself or your family down?
• Would you be better off dead?

The prefrontal cortex’s coping mechanism affecting focusing explains how I read the PHQ-9 as two questions. And the constant repetition of these did become a mantra, making them seem like assertions to me. But that was my personal experience. I still need to test the test through a less subjective method to see if the risk is there.

Seeking its core query, I’ve distilled the PHQ-9 through a refining system that consists of deleting five words at a time (six on the first stage to round it down to 100) without altering the text’s meaning. Once I reached the minimum amount of words per question, I started removing the less triggering questions. 

The final five words left say: would be better off dead. According to this, if we were to sum up the PHQ-9 in a single question (PHQ-1), it would be:

Do you think you would be better off dead?

For me, this was a suicide reminder. However, I did discuss it with a psychologist to hear their thoughts. We concluded that despite the new question losing its initial frequency measuring purpose (Over the last two weeks, how often) and becoming a binary choice – there is still a choice. There is the ‘NO’ option. What the PHQ-1 in disguise checks is whether the patient feels suicidal or not. The thing is that the question itself can boost how they feel. It might remind patients of their suicidal ideations, but it can also reaffirm the will to live if they’re experiencing progress. Either way, it reinforces their direction, which could affect their progress positively, but also comes with the risk of strengthening their suicidal side.

Feedback:

— highlighting the language this group uses is a nice addition. are there other ways you can do this (for example, including other specific language from NHS materials)?

— i like the inclusion of the self-assessment questions. they turn attention back to the urgency of the emotional questions, while also showing how uncomfortable it can be to use "survey" language to assess emotional wellbeing.

— i thought the red text was your own personal experience and reflections, but this one doesn't really fit in that category. have i misunderstood? 

— this level of detail is also really useful for people who are unaware of the range of treatments used for depression and anxiety. 

— you've come a long way with this piece. it now has a nice balance of personal experience, institutional context, medical context, etc. using different type treatments to differentiate these 'voices' is really useful.

— the main question now is: what else are you going to do with your writing? what else can live around this piece? what else can you accomplish with the writing?

— if you look back at the learning outcomes, you'll see that you haven't done much to contextualize this piece within GCD. there is loose enquiry/position 'enacted' through this piece, but it's very implicit. can you help the reader to understand how your use of GCD has developed your own understanding? can you put your work in relationship to other practices, other ideas about GCD, etc.?

Following the feedback from Triangulate 01.1, I turned the information I had documented into a cross-functional flowchart that includes the organisations, people involved and procedures. It aims to observe from a birds-eye view the process’ ramifications to help understand it.

It was then published as a 4-page tabloid newspaper along with an article I wrote about my experience seeking mental health support.

Depicting this muddled experience through a rigorous visual system did help understand why it felt the way it did. Plotting the route proved that the process is not unidirectional. It loops itself often, sometimes it splits into incompatible directions, and it has many dead ends. Even the trails that seem to move forward are repetitive patterns (i.e. referral – assessment – referral – assessment).

Everything that could be avoidable is labelled in red to try to correct the itinerary, aiming to pinpoint a clean way of doing it. There doesn’t appear to be any shortcuts though. We’re still left with a lengthy road after removing all the unnecessary steps. The issue seems to be the excess of entities encountered.

For the 1st studio-based practice I backtracked my path since I reached out for support from public institutions.

Feedback:

Right now all the viewer can see is chaos. Even if the purpose is to show chaos, it needs to be explained. Developing a strict and clear visual system might help.